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Morris Kutner, MD; Glenford Nixon, MD; Felix Silverstone, MD

Arch Intern Med. 1991;151(10):1950-1953.

Abstract
The use of oral anticoagulants and antiplatelet agents for the prevention of strokes in elderly patients with atrial fibrillation is controversial. Recent studies suggest that warfarin and aspirin can be safe and effective in selected patients. To determine attitudes toward this subject, we sent a questionnaire to 480 attending physicians at two major university-affiliated medical centers. Among the 251 responses (52.3%), 46 respondents (18.3%) used warfarin in atrial fibrillation of any cause, 175 (69.7%) used it in atrial fibrillation with transient ischemic attacks, 161 (64.1%) used it in patients with cerebrovascular accidents, and 196 (78.0%) used it in patients with mitral valve disease. One hundred twenty-nine (51.4%) believed that the risk of hemorrhage associated with warfarin outweighs the benefit, 61 (24.3%) were not convinced that warfarin prevents strokes in atrial fibrillation, and 42 (16.7%) believed it was difficult to monitor prothrombin time in the elderly because of poor compliance. Aspirin was used by 91 physicians (36.2%) in atrial fibrillation of any cause, 161 (64.1%) in patients with transient ischemic attacks, 140 (55.7%) in patients with cerebrovascular accidents, and 48 (19.1%) when patients were in sinus rhythm. We concluded that physicians are still hesitant to use oral anticoagulants and antiplatelet agents for the prevention of strokes in their elderly patients with atrial fibrillation. These agents are used most frequently after an ischemic episode (transient ischemic attack or cerebrovascular accident) has occurred or in patients with mitral valve disease.

(Arch Intern Med. 1991;151:1950-1953)

Author Affiliations
From the Department of Medicine, The Parker Jewish Geriatric Institute/Long Island Jewish Medical Center, New Hyde Park, NY (Drs Kutner and Silverstone); and the Department of Medicine, Winthrop University Hospital, Mineola, NY (Dr Nixon).

Footnotes
Accepted for publication March 21, 1991.

Presented as a poster at the annual meeting of the Gerontological Society of America, Boston, Mass, November 17, 1990.

Reprint requests to The Parker Jewish Geriatric Institute, 271-11 76th Ave, New Hyde Park, NY 11042 (Dr Kutner).

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